Remember to Wear Face Coverings and Maintain Social Distancing

COVID-19 Epidemiology

At Denver Health, hospitalized COVID-19 patients in isolation have increased over the past week. We have a total of 56 patients – 45 on general medicine, 11 in the ICU (10 vented).

Our laboratory positivity rate among those tested remains elevated at 16.2%, which is stable over this past week, but substantially higher than what we were seeing prior to Labor Day

Denver Cases:

As of today, there have been 20,375 confirmed cases of COVID-19 in Denver, including 462 deaths. Community case rates continue to increase. New cases of COVID-19 in Colorado increased again this week to 333.7 cases/day (7-day moving average) as our hospitalizations for the novel coronavirus also continued to climb. Case counts are increasing in all age groups. https://storymaps.arcgis.com/stories/50dbb5e7dfb6495292b71b7d8df56d0a

Colorado Cases:

There have been 114,709 confirmed cases of COVID-19 in Colorado, including 2,311 deaths among those patients. Colorado reported 2140.9 cases/day (7-day moving average) on November 2 as the coronavirus continues to surpass records in all parts of the state. Hospitalizations also have reached highest point since May 31, exceeding last week’s numbers, increasing from 126 low point in late June to 814 as of Nov 3—near our peak of 888 in April. https://covid19.colorado.gov/covid-19-data

US Cases:

There have been 9,268,818 confirmed cases of COVID-19 in the U.S., including 230,893 deaths. Over the past week, there has been an average of 85,563 cases per day, an increase of 44 percent from the average two weeks earlier. Case numbers in the United States continue to reach record levels in most of the nation, with only slightly lower activity in the west and northeast. Wisconsin and Texas have set up field hospitals. Deaths, though still well below their peak spring levels, have increased since July. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

Worldwide:

Globally there have been 46,840,783 confirmed cases of COVID-19, including 1,204,028 deaths reported to the World Health Organization (WHO). The further acceleration in the incidence of new cases was most notable in European Region, which reported half of global new cases (over 1.7 million cases - a 22% increase from the previous week. Moreover, the region also reported a substantial rise in the number of new deaths (a 46% increase compared with the previous week). https://covid19.who.int/

PPE Supply Updates

Nitrile glove usage is below our weekly allocation last week, and we have between 45 and 60 days back up supply. We will continue to buy gloves from reputable suppliers to keep this stock around the 60 day level. Disposable isolation gown usage increased this week as our Covid patient numbers increased but they are still below our weekly allocation, which we are receiving in full. We will review this week if we need to top-up supply. All N95 respirators have shown significant increases in the last weeks. However, we still have good levels of stocks of the 3M 1860 and 1860S, plus very significant stocks of 3M alternatives. We still have around 100 days’ supply of both 1860 and 1860S and are receiving our usual weekly shipments. On the Halyard duckbills we were able secure extra supplies of both sizes. The duckbill regular has seen the most significant increase, but the extra supplies arrived on Friday and will reflect in our numbers early this week. Stock of our regular Halyard procedure mask has increased with flu season but we are using less than we’re buying in a week and on top of that we have the quarter million in backup stock. Purple top wipe usage is stable and we are issuing about half the amount we are buying, we are receiving our full allocation and have built up reserve stocks and we have no concern on the supply.

Updated dashboard of PPE supply to be transferred to our COVID-19 subsite and updated weekly

Source: Stewart Layhe, Materials Management

Preventing COVID-19 in Our Workforce

Some of you have asked about testing data in employees, and I’m happy to share what I know. Among those tested, our percentage of positive tests among employees appears to be similar to percentage of positive tests in our community. Pooling all our testing data from June 1- November 1, 2020, employees’ positivity rate was 6% and those tested at DH from our community was 7%.

Recent experience that suggests that most of our healthcare worker transmissions are occurring outside of direct patient care. This is probably related to how we protect ourselves when our guard is let down- whether it be in the community, in our interactions in breakrooms, clinical “bullpens”, during lunchtime, and at work.

Some reminders to keep you safe, both during and outside of patient care:

Outside of patient care

Face coverings must be worn when at all times when indoors, except in the following circumstances

· When eating or drinking, and then only when appropriate distancing can be maintained

· When alone in a private office with the door closed

Face coverings are also to be worn outdoors on the campus unless six feet distancing can be assured

During patient care

PPE works! Make sure you use PPE, and use it correctly.

Our HITeam has been doing PPE training sessions throughout organization. Here is the upcoming ACS dates:

11/04/2020 1300-1400 Ortho Speciality Clinic

0800-0900 West Side Pediatrics (2nd mtg)

11/6/2020 0900-1000 HeadStart-School Based (Zoom)

11/9/2020 12:15-1300 PAV C OB/GYN Clinic

11/10/2020 1430-1530 WestSide Adult

11/11/2020 1215-1315 Eastside Pediatric Clinic

11/12/2020 0730-0900 Adult Hepatic/Gastric CLinic Pav D

In our inpatient setting, additional dates to be announced shortly!

For more information on PPE training , email HITeam@dhha.org

Finally, a recent study in JAMA suggests benefit of face shields in preventing COVID-19 infections. https://jamanetwork.com/journals/jama/fullarticle/2769693. Infection Prevention highly encourages use of these as an extra layer of protection over your mask during patient care and while in open work areas.

RISE Up Staff Support Center Now in Pav. A

The RISE Up Staff Support Center has moved to a new location. This week, the Center relocated to the second floor of Pavilion A, outside of the elevators. The new location is in the former waiting room of the Surgical Intensive Care Unit. The RISE (Resilience in Stressful Events) Up Staff Support Center provides a welcoming drop-in space for staff members to get emotional support and psychological first aid from a trained peer responder. Click here for a schedule of upcoming virtual group support sessions. At this time, the Center’s hours remain the same: 2:30 – 8:30 p.m., seven days a week.

The Hospital Incident Command Center has been Activated

Based on rising COVID-19 cases in the community and our own inpatient numbers, we have reactivated the Hospital Incident Command Center. The well-proven structure enables effective management, resource allocation and provides the basis for communication to deal with our response to the coronavirus.

We will provide a summary of the Hospital Incident Command structure in a document located on our COVID-19 subsite

We have two objectives as we enter into this next phase of the pandemic.

Commitment to Safety – we are committed to the safety of our employees, patients and visitors. We must take care of ourselves so that we can take care of our patients, coworkers and community.

Commitment to Community – we will always be here to for the people of Denver, to provide care in-person or virtually, on campus or at one of our locations across the city.

From tomorrow, Wednesday, November 4, 2020, instead of my weekly communication, there will be a COVID-19 email and huddle sheet that will be sent to all staff on a daily basis while Incident Command is activated. This will include updates, information and resources.

If you wish to contact the command center, please email COVID-19@dhha.org with any questions.

Policy Reminders

Where can I find more information about testing for staff?

Click here for the Staff Screening and Testing FAQ.

Universal Masking

Remember that the universal masking policy applies to all staff, patients and visitors across all Denver Health locations. This includes while in hallways and transporting patients.

· Clinical staff members are required to wear a mask or a respirator that is appropriate to their environment of care at all times. See the details here.

· Non-clinical staff members are required to wear a face covering in any shared, indoor space – even while sitting in physically distanced cubicles. Learn more here.

· Patients and visitors are also required to wear a mask or a face covering. Supplies are available at hospital entrances.

Hand Hygiene

· All employees and contractors who have direct patient contact must follow the Hand Hygiene Policy.

· Wash your hands frequently with soap and water for at least 20 seconds or use hand sanitizer provided by Denver Health.

Social Distancing

Social distancing is critical to reduce the risk of transmission. It’s also important that we lead by example. Remember to stay at least six feet away from others unless it’s required for patient care while using appropriate PPE. Staying six feet away also means skipping the handshake. Social distancing is even more critical when your mask is removed (for example, when eating and drinking). Keep your distance in the cafeteria and at off-campus restaurants. Skip the Break Room in your work area and instead bring your lunch outside.

Infection Prevention Best Practice Quick Reference

COVID-19:

· N95 Mask Options and Mask Labeling

· PPE Algorithm

· Donning and Doffing Instructions

· Isolation Clearance Recommendations

· Other Personal Protective Equipment (PPE) Questions

· Centers for Disease Control (CDC) and Colorado Department of Public Health & Environment (CDPHE) Resources

Policies:

· Hand Hygiene

· Standard Precautions

· Isolation/Transmission-based Precautions

Quick Videos:

· World Health Organization (WHO): How to wash hands with soap and water

· WHO: How to wash hands with alcohol-based hand sanitizer

Denver Health Coronavirus Resources:

· Denver Health External Website for Staff

· Denver Health Pulse Subsite

· RISE – Peer Support for Caregivers in Distress

Helpful Links:

· Colorado Department of Public Health and Environment Coronavirus Information

· Denver Department of Public Health and Environment Coronavirus Information

· Centers for Disease Control and Prevention Coronavirus Information

· Denver Public Health Website

Thank you for everything you do for Denver Health!

Connie Savor Price, MD
Chief Medical Officer
Denver Health and Hospital
Professor of Medicine

Division of Infectious Diseases
University of Colorado School of Medicine


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